|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
948100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
940100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947200113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
949000305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
949000305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
940100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947200113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947300113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
946000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,708.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,708.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,708.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,708.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
947000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$3,597.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$719.40 |
| Max. Negotiated Rate |
$3,237.30 |
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,877.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,438.80
|
| Rate for Payer: Galaxy Health WC |
$3,057.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,158.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,237.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,399.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,370.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.40
|
| Rate for Payer: Multiplan Commercial |
$2,697.75
|
| Rate for Payer: Networks By Design Commercial |
$2,338.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,057.45
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
OP
|
$3,597.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,158.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,877.60
|
| Rate for Payer: Cigna of CA PPO |
$2,661.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,057.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,158.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,237.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,697.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,399.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$2,697.75
|
| Rate for Payer: Networks By Design Commercial |
$2,338.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,057.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,158.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$8,196.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$7,376.40 |
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,278.40
|
| Rate for Payer: Galaxy Health WC |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,376.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,466.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,122.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.20
|
| Rate for Payer: Multiplan Commercial |
$6,147.00
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$8,196.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.37 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,917.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,830.79
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Cigna of CA PPO |
$6,065.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Dignity Health Media |
$4,830.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,313.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,521.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,830.79
|
| Rate for Payer: Galaxy Health WC |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,376.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,147.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,922.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,830.79
|
| Rate for Payer: InnovAge PACE Commercial |
$7,246.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,466.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,830.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,473.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,473.26
|
| Rate for Payer: Multiplan Commercial |
$6,147.00
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
| Rate for Payer: Prime Health Services Medicare |
$5,120.64
|
| Rate for Payer: Riverside University Health System MISP |
$5,313.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,917.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,098.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,098.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,098.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,098.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
